The Value of Health Economics and Outcomes Research in Prosthetics and Orthotics.

The demand has increased for evidence regarding the effectiveness and value of prosthetic and orthotic rehabilitation interventions. Clinicians and managers are under pressure to provide treatment recommendations and demonstrate effectiveness through outcomes. It is often assumed that rehabilitation interventions, including the provision of custom-made and custom-fit orthotic and prosthetic devices, are beneficial to patients. Assessing the value of orthotic and prosthetic services has become more critical to continue to ensure equitable access to needed services. Health economics and outcomes research methods serve as tools to gauge the value of prosthetic and orthotic rehabilitation interventions. The purpose of this article is to provide an overview of the current need of health economics and outcomes research in orthotics and prosthetics, to introduce common economic methods that assist to generate real-world evidence, and to discusses the potential value of economic methods for clinicians and clinical practice.

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study.

INTRODUCTION: Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts. OBJECTIVES: The purposes of this study are to describe the intensity of community programs and policies (CPPs) to address childhood obesity in 130 US communities and to examine the extent to which observed CPPs targeted multiple behaviours and employed a comprehensive array of strategies. METHODS: To document CPPs occurring over a 10-year period, key informants were interviewed using a semi-structured interview protocol. Staff coded CPPs for key characteristics related to intensity, including reach, duration and strategy. Three types of CPP scores were calculated for intensity of CPPs, targeting of CPPs towards multiple behaviours and strategies used. RESULTS: Nine thousand six hundred eighty-one CPPs were identified. On average, communities had 74 different CPPs in place (standard deviation 30), with variation in documented CPPs (range 25-295). Most communities experienced a steady, modest increase in intensity scores over 10 years. CPP targeting scores suggested that communities expanded the focus of their efforts over time to include more behaviours and strategies. CONCLUSIONS: Findings of this large-scale study indicate that great variation exists across communities in the intensity and focus of community interventions being implemented to address childhood obesity.

Reliability and validity of the compliance belief scales among patients with heart failure.

BACKGROUND: Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior. OBJECTIVE: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure. THEORETICAL FRAMEWORK: This study's theoretical framework is the Health Belief Model. METHODS: A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview. RESULTS: Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed. CONCLUSIONS: The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs.

Gender differences in the associations of self esteem, stress and social support with functional health status among older adults with heart disease.

This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors were controlled. Men were significantly more likely than women to maintain or improve in functioning. Self esteem, stress, compliance with medication regimens, and marital status were significantly associated with maintenance or improvement of functioning among women. Only age and stress were significantly associated with maintenance or improvement in functioning among men. Findings indicated that: (1) stress and self esteem were stronger predictors of functioning, especially among women, than demographic and clinical factors; and (2) women in the highest quartile of the self esteem distribution were approximately five times as likely to maintain or improve their functioning as women in the lowest quartile.

Coordination of a neural tissue transplantation study in patients with posttraumatic syringomyelia.

The need for clinical research coordinators (CRCs) has grown in recent years due to the increasingly rapid translation of scientific advances from preclinical experiments to clinical trials. CRCs perform a number of critical roles in clinical trials, such as ensuring adherence to the research protocol and careful monitoring of the study data. Although many of these duties are now standardized in a general job description, new fields of clinical research may require additional functions of the CRC that are specific to each investigation. This was the case for a pilot clinical study at the University of Florida, which investigated the feasibility and safety of human fetal spinal cord (FSC) tissue allografts in patients with progressive posttraumatic syringomyelia (PTS). The CRC for this study had several essential duties, such as arranging transportation for PTS subjects to the study center from all regions of the United States and coordinating an extensive assessment protocol that required many co-investigators. Given these challenges, successful achievement of the outcome measures required the development of a customized CRC job description that encompassed both standard roles and specific duties for this study. Accordingly, this article will illustrate the role of the CRC in this study and provide a template for similar coordinator roles.

Developing youth capacity for community-based research: the Sarasota County demonstration project.

Although youth involvement in health promotion efforts is not a new concept, projects that actively involve youths in planning research, collecting data, and making research design decisions are rare. This article describes the evaluation process and outcomes for a youth-directed data collection initiative. Eleven youth researchers conducted 112 personal in-depth interviews and 22 focus groups involving 206 youths in 5th through 12th grade. Youth researchers felt confident they could conduct focus groups and in-depth interviews and staff ratings of youths' effectiveness in moderating focus groups indicated they were successful in carrying out the qualitative research.

Healthcare costs of patients with heart failure treated with torasemide or furosemide.

OBJECTIVE: To compare the direct healthcare costs of patients with congestive heart failure (CHF) prescribed torasemide (torsemide) or furosemide (frusemide). DESIGN AND SETTING: As part of a prospective, randomised, nonblind study, we assessed the effects of torasemide and furosemide on readmission to hospital in 193 patients treated for CHF at a US urban public healthcare system. We also calculated total direct healthcare costs for the 2 drugs. The perspective of the analysis was that of the healthcare system. Healthcare charge and utilisation data, demographic information, and health status data were obtained from an electronic database containing data for all patients treated within the healthcare system. PATIENTS AND PARTICIPANTS: Upon admission to the hospital, patients were eligible if they had evidence of left ventricular systolic dysfunction, were at least 18 years old, and were receiving furosemide. INTERVENTION: Inpatients were randomised to either torasemide or furosemide treatment for 1 year. MAIN OUTCOME MEASURES AND RESULTS: Patients treated with torasemide had fewer hospital admissions than those treated with furosemide [18 vs 34% for CHF (p = 0.013) and 38 vs 58% for any cardiovascular cause (p = 0.005)]. In the torasemide group, expected annual hospital costs per patient were lower for CHF admissions (by $US1054; 1998 values) and for all cardiovascular admissions (by $US1545) than in the furosemide group. Because the annual acquisition cost of torasemide was $US518 per patient higher than that of furosemide, the resulting net cost saving per patient was $US536 for CHF and $US1027 for all cardiovascular causes. Outpatient costs did not differ between treatment groups regardless of whether drug costs were considered. Total direct costs were $US2124 lower with torasemide than with furosemide (not statistically significant). CONCLUSIONS: Owing largely to reduced readmission to the hospital, the cost of inpatient care for patients with CHF is significantly lower with torasemide than with furosemide, despite the higher acquisition cost of torasemide. Treatment with torasemide resulted in a nonsignificant reduction in total direct costs (outpatient plus inpatient) compared with furosemide.

The social consequences of psychiatric disorders, III: probability of marital stability.

OBJECTIVE: The associations of prior DSM-III-R disorders with probability and timing of subsequent divorce were examined. METHOD: The data came from the part II subsample (N=5,877) of the National Comorbidity Survey. The respondents completed a structured diagnostic interview that retrospectively dated age at onset of each of 14 lifetime DSM-III-R disorders and recorded ages at first marriage and divorce. These data were used to estimate survival models describing the relationships between prior disorders and subsequent divorce. In addition, simulations were used to estimate the number of years spent out of marriage because of these causal relationships in the total U.S. population. RESULTS: Prior psychiatric disorders were associated with a substantially higher risk of divorce. The simulations suggested that the effects of these associations in the U.S. population in the survey's age range are approximately 23 million lost years of marriage among men and 48 million lost years of marriage among women. CONCLUSIONS: Psychiatric disorders have a number of adverse consequences for those who suffer from them and for their families and communities. The results reported here suggest that an increase in the number of people who divorce and a decrease in the number of years of marriage in the population may be among them. The debate over whether society can afford to provide universal treatment for psychiatric disorders needs to take these costs into consideration.

The effects of psychiatric disorders on the probability and timing of first marriage.

While studies of psychopathology have begun to consider social consequences of psychiatric disorders during the past decade, marriage has received little attention, despite evidence that it influences life quality. The present paper examines the effects of clinically significant psychiatric disorders on the probability and timing of first marriage and whether the relationships between psychiatric disorders and marriage differ by type of disorder, gender, and birth cohort. Psychiatric disorders are found to have substantial effects on entry into first marriage. These effects are the same for men and women across all cohorts. Individual psychiatric disorders have similar effects on entry into first marriage. Psychiatric disorders are positively associated with early first marriage, which is strongly related to adverse consequences, and negatively associated with on-time and late first marriage, which are related to benefits such as financial security and social support. These results highlight the importance of early interventions for psychiatric disorders-if not for the purposes of primary prevention, then for the purposes of preventing the cumulation of adversities that occur secondarily through early marriage.